Provider Demographics
NPI:1063583417
Name:BEHAVIORAL HEALTH PROVIDERS P C
Entity type:Organization
Organization Name:BEHAVIORAL HEALTH PROVIDERS P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MCTAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:888-291-2538
Mailing Address - Street 1:1100 COUGAR TRL
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-6057
Mailing Address - Country:US
Mailing Address - Phone:888-291-2538
Mailing Address - Fax:847-516-2510
Practice Address - Street 1:1100 COUGAR TRL
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-6057
Practice Address - Country:US
Practice Address - Phone:888-291-2538
Practice Address - Fax:847-516-2510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.005495101YP2500X
IL180.006237101YP2500X
IL149.0071411041C0700X
IL071.004573103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty